Provider Demographics
NPI:1568568475
Name:HOPPER MEDICAL CLINIC
Entity Type:Organization
Organization Name:HOPPER MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-786-9088
Mailing Address - Street 1:601 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-3429
Mailing Address - Country:US
Mailing Address - Phone:918-786-9088
Mailing Address - Fax:918-786-9682
Practice Address - Street 1:601 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-3429
Practice Address - Country:US
Practice Address - Phone:918-786-9088
Practice Address - Fax:918-786-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty